# CCM SPECIALISTS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891183984
- **Authorized official:** DR. AJAY K DHAWAN MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (239) 699-5830

## Contact information

- **Practice address:** 1108 AMBER LAKE CT, CAPE CORAL, FL 33909
- **Practice address phone:** (425) 270-5432
- **Mailing address:** 1108 AMBER LAKE CT, CAPE CORAL, FL 33909
- **Mailing address phone:** (425) 270-5432

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | ME105093 | FL | Yes |

## Other

- **Enumeration date:** 12/26/2014
- **Last updated:** 12/26/2014